There is an urgent need for evidence-based interventions to reduce risk of musculoskeletal disorders (MSDs) and improve health and safety behaviors for low-income workers. These health outcomes share common pathways through the work organization. Upstream interventions addressing these organizational characteristics and work experiences may be especially effective in preventing adverse health outcomes because they address underlying sources of elevated risk, and may be particularly important for low-wage workers. Compared to higher earning workers, low-wage workers have less schedule control, more irregular working hours, and shortened breaks due to time pressure to complete work tasks. The objective of this study is develop and test feasible intervention methods to modify the work organization and contribute to reductions in MSD risk and improvements in dietary patterns among one group of low-income workers: food service workers. The food service industry employs 9.5 million workers in the U.S, many of whom are at elevated risk for a range of poor health outcomes. NIOSH's Total Worker Health(tm) (TWH) Program provides an innovative approach for addressing the shared pathways in the work organization and environment that impact both MSD risk and health and safety behaviors. This study takes advantage of an unusual opportunity to demonstrate the impact of changes in the work organization in collaboration with an industry partner that has committed to making such changes in concert with this study. Our central hypothesis is that an intervention targeting the work organization, as well as the work environment and individual health and safety behaviors, will show promising improvements in MSD outcomes and dietary patterns. This study focuses on two aims. First, this study will identify characteristics of the work organization that can be feasibly modified through changes in management practices, based on interviews with food service managers and focus groups with workers. Second, we will determine the feasibility and potential efficacy of an integrated TWH intervention in improving workers' ergonomic practices, MSD symptoms and dietary patterns, as well as in changing the work organization and environment. This intervention will be tested in a proof-of-concept trial in 10 food service worksites randomly assigned to intervention and control. The 16-month intervention will target changes in the organizational and physical work environment and management practices, and supporting safe ergonomic practices and healthful dietary patterns. We will compare differences between intervention and control sites in changes between pre- and post-intervention in worker health and safety behaviors and MSD symptoms through surveys of workers, and in the work organization and environment through manager surveys and on-site walk-through's. A rigorous process evaluation will be used to assess intervention feasibility. The contribution of this study will be significant because it is expected to contribute to reducing disparities in these health outcomes by directly intervening on an underlying source of these disparities.